{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:32:50Z","timestamp":1771979570952,"version":"3.50.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":688,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["20IPA35310955"],"award-info":[{"award-number":["20IPA35310955"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["20IPA35310955"],"award-info":[{"award-number":["20IPA35310955"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In this case series, we describe the use of invasive cardiopulmonary exercise testing (iCPET) to diagnose heart failure due to preload reserve failure in two patients with progressive dyspnoea. We demonstrate that underlying liver disease contributes to preload reserve failure as a cause of exertional dysfunction. In liver diseases such as non-alcoholic fatty liver disease (NAFLD), fibrotic changes to the sinusoidal liver architecture occur leading to an increased transhepatic sinusoidal pressure gradient. Even at the earliest stage of hepatic fibrosis in patients with NAFLD, changes in hepatic blood flow are seen due to outflow block in the sinusoidal area. In this way, changes to the sinusoidal liver architecture can lead to limitations in preload reserve. This case series describes two patients with exertional dyspnoea found to have preload failure on iCPET due to underlying liver disease.<\/jats:p>","DOI":"10.1002\/ehf2.14598","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T21:54:52Z","timestamp":1701122092000},"page":"587-593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Use of Invasive Cardiopulmonary Exercise Testing to Diagnose Preload Reserve Failure in Patients with Liver Disease"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8149-1774","authenticated-orcid":false,"given":"Carolyn G.","family":"Ahlers","sequence":"first","affiliation":[{"name":"Department of Medicine, Duke University Hospital , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Atrium Health Sanger Heart and Vascular Institute , Concord, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kishan","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Hospital , Durham, NC ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marat","family":"Fudim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Hospital , Durham, NC ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]},{"name":"Department of Cardiology, University of Wroc\u0142aw , Wroc\u0142aw ,","place":["Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"2026012113072424100_ehf214598-bib-0001","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1002\/hep.27869","article-title":"Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: A population-based study","volume":"62","author":"VanWagner","year":"2015","journal-title":"Hepatology"},{"key":"2026012113072424100_ehf214598-bib-0002","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.007308","article-title":"Extracardiac abnormalities of preload reserve: Mechanisms underlying exercise limitation in heart failure with preserved ejection fraction, autonomic dysfunction, and liver disease","volume":"14","author":"Fudim","year":"2021","journal-title":"Circ Heart Fail"},{"key":"2026012113072424100_ehf214598-bib-0003","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.jacbts.2021.07.010","article-title":"Relationship of nonalcoholic fatty liver disease and heart failure with preserved ejection fraction","volume":"6","author":"Salah","year":"2021","journal-title":"JACC Basic Transl Sci"},{"key":"2026012113072424100_ehf214598-bib-0004","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.117.004750","article-title":"Pulmonary capillary wedge pressure patterns during exercise predict exercise capacity and incident heart failure","volume":"11","author":"Eisman","year":"2018","journal-title":"Circ Heart Fail"},{"key":"2026012113072424100_ehf214598-bib-0005","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701","article-title":"Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction","volume":"3","author":"Borlaug","year":"2010","journal-title":"Circ Heart Fail"},{"key":"2026012113072424100_ehf214598-bib-0006","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.121.008982","article-title":"Unexplained dyspnea on exertion: The difference the right test can make","volume":"15","author":"Rao","year":"2022","journal-title":"Circ Heart Fail"},{"key":"2026012113072424100_ehf214598-bib-0007","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1086\/685054","article-title":"Unexplained exertional dyspnea caused by low ventricular filling pressures: Results from clinical invasive cardiopulmonary exercise testing","volume":"6","author":"Oldham","year":"2016","journal-title":"Pulm Circ"},{"key":"2026012113072424100_ehf214598-bib-0008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/191807","article-title":"Hemodynamic changes during a deep inspiration maneuver predict fluid responsiveness in spontaneously breathing patients","volume":"2012","author":"Pr\u00e9au","year":"2012","journal-title":"Cardiol Res Pract"},{"key":"2026012113072424100_ehf214598-bib-0009","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.021654","article-title":"Nonalcoholic fatty liver disease and risk of heart failure among Medicare beneficiaries","volume":"10","author":"Fudim","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026012113072424100_ehf214598-bib-0010","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1148\/radiol.14132952","article-title":"Nonalcoholic fatty liver disease: Portal hypertension due to outflow block in patients without cirrhosis","volume":"274","author":"Hirooka","year":"2015","journal-title":"Radiology"},{"key":"2026012113072424100_ehf214598-bib-0011","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1253\/circj.CJ-15-0064","article-title":"Diastolic dysfunction","volume":"79","author":"Jeong","year":"2015","journal-title":"Circ J"},{"key":"2026012113072424100_ehf214598-bib-0012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.hfc.2007.10.004","article-title":"The cardiac cycle and the physiologic basis of left ventricular contraction, ejection, relaxation, and filling","volume":"4","author":"Fukuta","year":"2008","journal-title":"Heart Fail Clin"},{"key":"2026012113072424100_ehf214598-bib-0013","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.mehy.2012.06.001","article-title":"Ejection fraction in patients with heart failure and preserved ejection fraction is greater than that in controls\u2014A mechanism facilitating left ventricular filling and maximizing cardiac output","volume":"79","author":"Dori","year":"2012","journal-title":"Med Hypotheses"},{"key":"2026012113072424100_ehf214598-bib-0014","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.010114","article-title":"Diastolic ventricular interaction in heart failure with preserved ejection fraction","volume":"8","author":"Parasuraman","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2026012113072424100_ehf214598-bib-0015","doi-asserted-by":"crossref","first-page":"151","DOI":"10.14503\/THIJ-15-5678","article-title":"Obstructive sleep apnea in heart failure: Review of prevalence, treatment with continuous positive airway pressure, and prognosis","volume":"45","author":"Khattak","year":"2018","journal-title":"Tex Heart Inst J"},{"key":"2026012113072424100_ehf214598-bib-0016","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3350\/cmh.2014.20.1.6","article-title":"Hepatic venous pressure gradient: Clinical use in chronic liver disease","volume":"20","author":"Suk","year":"2014","journal-title":"Clin Mol Hepatol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/1\/587\/64509075\/eschf_11_1_587.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/11\/1\/587\/64509075\/eschf_11_1_587.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:07:49Z","timestamp":1769018869000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/11\/1\/587\/8268212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,27]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,11,27]]},"published-print":{"date-parts":[[2024,2,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.14598","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2]]},"published":{"date-parts":[[2023,11,27]]},"assertion":[{"value":"2023-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}